scholarly journals Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management

2020 ◽  
Author(s):  
Ha Eun Park ◽  
Sarah J Billups ◽  
Lisa M Schilling
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Qualitative Interviews ◽  
Patient Characteristics ◽  
Reduce Blood Pressure ◽  
Educational Resources ◽  
National Guidelines ◽  
Dash Diet ◽  
First Line Therapy

Abstract BackgroundThe Dietary Approach to Stopping Hypertension (DASH) is proven to lower systolic and diastolic blood pressure up to 7.8 and 3.7 mmHg, respectively and is considered first-line therapy per national guidelines. Yet, implementation into clinical practice remains suboptimal. MethodsWe designed a provider survey to identify and characterize physician-identified barriers to providing DASH diet to eligible primary care patients to reduce blood pressure. The survey assessed four domains: (1) provider beliefs/knowledge of DASH benefits (2) patient characteristics influencing likelihood of recommendation, (3) practice barriers to provision of DASH diet advice/education, and (4) resources necessary to facilitate use. We conducted qualitative interviews with 4 primary care physicians and designed a 7-item Likert scale-based survey.Participants: University of Colorado affiliated primary care clinics and School of medicine faculty providers working in Denver metro.ResultsThe survey was sent electronically to 149 providers, with 49 (33%) responders. Most providers (65%) believed DASH diet is as effective at lowering blood pressure as adding a medication for patients with pre-hypertension and established hypertension. Providers identified perceived low patient motivation (88%) and low ability to implement DASH diet into patient’s lifestyle (88%) as patient factors influencing their decision to provide DASH diet education. The most significant practice barriers were lack of time (71%) and lack of patient-directed educational resources (67%). Resources providers would find useful included resources accessible through the electronic medical record, (88%), a dietician (83%), and printed patient education materials (59%).ConclusionMost physicians believe DASH diet is effective at lowering blood pressure. The most common barriers to providing DASH education are low perceived patient ability or motivation, lack of provider time, and lack of patient-directed educational resources. Providers identified that readily available electronic and printed materials and access to dieticians would help improve DASH counseling in practice.

Abstract P136: Healthier Personal Habits Of Primary Care Physicians Increase The Likelihood Of Their Recommending Lifestyle Modifications For Their Hypertensive Patients That Are Consistent With The National Guidelines

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Olivia Y Hung ◽  
Nora L Keenan ◽  
Jing Fang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Blood Pressure ◽  
Primary Care Physicians ◽  
Lifestyle Modification ◽  
Lifestyle Interventions ◽  
Lifestyle Modifications ◽  
Hypertensive Patients ◽  
Attitudes And Behaviors ◽  
And Behaviors

Introduction: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians’ personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. Hypothesis: Primary care physicians who have healthier habits, as defined by eating more cups of fruits and/or vegetables, exercising more frequently, and/or not smoking, would be more likely to recommend lifestyle interventions consistent with JNC VII than their counterparts who have less healthy habits. Methods: One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. Results: The respondents’ average age was 45.3 years and 68.5% (685 of 1000) were male. In regards to physician behavior, 4.0% (40 of 1000) smoked at least once a week, 38.6% (386 of 1000) ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% (274 of 1000) exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (922 of 1000), or cut down on salt (961 of 1000), or attain or maintain a healthy weight (948 of 1000), or limit the use of alcohol (754 of 1000), or be physically active (944 of 1000). Collectively, 66.5% (665 of 1000) made all 5 lifestyle modification recommendations. Physicians who were between 40 - 49 years old were 1.6 times as likely of making all 5 lifestyle recommendations compared with those who were under 40 years. Additionally, those who exercised at least once per week or did not actively smoke were approximately twice as likely to recommend these interventions. Conclusions: The probability of recommending all five lifestyle modifications increased with both the physician exercising at least once per week and not having smoked.

scholarly journals The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5656
Author(s):  
Krzysztof Studziński ◽  
Tomasz Tomasik ◽  
Adam Windak ◽  
Maciej Banach ◽  
Ewa Wójtowicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Primary Care Patient ◽  
Care Patient ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Rural Primary Care

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.

scholarly journals Primary Care Resident Training for Obesity, Nutrition, and Physical Activity Counseling: A Mixed-Methods Study

2016 ◽  
Vol 18 (5) ◽  
pp. 672-680 ◽  
Author(s):  
Elizabeth L. Antognoli ◽  
Eileen L. Seeholzer ◽  
Heidi Gullett ◽  
Brigid Jackson ◽  
Samantha Smith ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Mixed Methods ◽  
Primary Care Physicians ◽  
Medical Training ◽  
Resident Training ◽  
National Guidelines ◽  
Residency Programs ◽  
Postgraduate Medical Training ◽  
Nutrition And Physical Activity

National guidelines have been established to support the role of primary care physicians in addressing obesity. Preparing primary care residents to recognize and treat overweight/obesity has been identified as an essential component of postgraduate medical training that is currently lacking. This study aims to identify how primary care residency programs are preparing physicians to counsel about obesity, nutrition, and physical activity (ONPA) and to examine program members’ perspectives regarding the place of ONPA counseling in the curriculum, and its relevance in primary care training. Using mixed methods, we collected and analyzed data on 25 family medicine, internal medicine, and obstetrics/gynecology residency programs across Ohio. Programs averaged 2.8 hours of ONPA-related didactics per year. Ten programs (42%) taught techniques for health behavior counseling. Having any ONPA-related didactics was associated with greater counseling knowledge (p = .01) among residents but poorer attitudes (p < .001) and poorer perceived professional norms (p = .004) toward ONPA counseling. Findings from interview data highlighted similar perceived barriers to ONPA counseling across all three specialties but variation in perception of responsibility to provide ONPA counseling. While widespread expectations that primary care physicians counsel their overweight and obese patients prevail, few residency programs provide training to support such counseling.

Variations in health services utilization by primary care patients

2002 ◽  
Vol 15 (2) ◽  
pp. 116-125 ◽  
Author(s):  
Victoria Bolaños-Carmona ◽  
Ricardo Ocaña-Riola ◽  
Alexandra Prados-Torres ◽  
Pilar Gutiérrez-Cuadra
Keyword(s):  
Primary Care ◽  
Health Service ◽  
Primary Care Physicians ◽  
Service Use ◽  
Patient Characteristics ◽  
Important Variable ◽  
Services Utilization ◽  
Care Groups ◽  
Physician Characteristics ◽  
Primary Care Patients

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

scholarly journals Physicians’ experiences of SBIRT training and implementation for SUD management in primary care in the UAE: a qualitative study

2017 ◽  
Vol 19 (04) ◽  
pp. 344-354
Author(s):  
Christiane Pflanz-Sinclair ◽  
Catriona Matheson ◽  
Christine M. Bond ◽  
Amna Almarzouqi ◽  
Amanda J. Lee ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Qualitative Study ◽  
Primary Care Physicians ◽  
Substance Misuse ◽  
Care Pathway ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Successful Implementation ◽  
Cultural Issues

AimThe objective of this paper is to present a qualitative study of introducing substance misuse screening using the Screening Brief Intervention and Referral to Treatment (SBIRT) model, in primary care in Abu Dhabi.BackgroundSubstance misuse in the UAE is an increasing problem. However religious beliefs and fear of legal consequences have prevented this topic from being openly discussed, risk levels identified through screening and treatment options offered.MethodsA controlled trial was undertaken which included a qualitative process study which is reported here. Qualitative interviews with primary care physicians from two intervention clinics were undertaken to explore their views, experiences and attitudes towards substance misuse management in their clinic. Physicians were trained on SBIRT and on the research project process and documentation. At completion of the project, 10 months after the training, physicians (n=17) were invited to participate in an interview to explore their experiences of training and implementation of SBIRT. Interviews were recorded and transcribed. Inductive thematic coding was applied.FindingsIn total, 11 physicians were interviewed and three main themes emerged: (1) The SBIRT screening project, (2) cultural issues and (3) patient follow-up. Findings revealed a general willingness toward the concept of screening and delivering brief interventions in primary care although increased workload and uncertainties about remuneration for the service may be a barrier to future implementation. There was a perceived problem of substance misuse that was not currently being met and a strong perception that patients were not willing to reveal substance use due cultural barriers and fear of police involvement. In conclusion this qualitative process evaluation provided essential insight into implementing SBIRT in the Middle East. In conclusion, despite physician willingness and a clinical need for a substance misuse care pathway, the reluctance among patients to admit to substance use in this culture needs to be addressed to enable successful implementation.

Challenges and strategies for hypertension management: qualitative analysis of small primary care practices with varying blood pressure control

2019 ◽  
Vol 36 (5) ◽  
pp. 644-649 ◽  
Author(s):  
Jenny R Smolen ◽  
Jason J Wang ◽  
Sheila P Anane
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Qualitative Interviews ◽  
Pressure Control ◽  
Care Practice ◽  
Hypertension Management ◽  
Small Primary ◽  
Average Control ◽  
High Control

Abstract Background Electronic health record (EHR) data on blood pressure (BP) control among patients with hypertension show that practices’ rates vary greatly. This suggests providers use different approaches in managing hypertension, and so we aimed to explore challenges small primary care practice providers face and strategies they use to manage patients’ BP. We explored differences between providers with high and low BP control rates to help inform future quality improvement work. Methods In 2015, we recruited practices in New York City with five or fewer providers. We employed a stratified purposeful sampling method, using EHR data to categorize small practices into groups based on the proportion of patients with hypertension whose last BP was <140/90: high control (>= 80%), average control (60–80%) and low control (<60%). We conducted semi-structured qualitative interviews with clinicians from 23 practices—7 high control, 10 average control and 6 low control—regarding hypertension management. We used a combined inductive/deductive approach to identify key themes, and these themes guided a comparison of high and low BP control providers. Results Small practice providers reported treatment non-adherence as one of the primary challenges in managing patients’ hypertension, and described using patient education, relationship building and self-management tools to address this issue. Providers differed qualitatively in the way they described using these strategies; high BP control providers described more actively engaging and listening to patients than low control providers did. Conclusions How providers communicate with patients may impact outcomes—future quality improvement initiatives should consider trainings to improve patient–provider communication.

Home Telemonitoring of Arterial Hypertension with Antihypertensive Treatment Titration: Protocol of a Randomized Controlled Prospective Trial (HOROSCOPE Study) (Preprint)

2020 ◽  
Author(s):  
SONIA Ben Hafaiedh ◽  
Yosra Ben Daya ◽  
Amina Hadjer Radoui ◽  
Mohamed Bouchoucha ◽  
Rabie Razgallah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Treatment Compliance ◽  
Therapeutic Education ◽  
Randomized Controlled ◽  
Sahel Region

BACKGROUND Despite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure (BP) control. OBJECTIVE The aim of this study is to evaluate the effects of telemonitoring with anti-hypertensive treatment titration on blood pressure control in Tunisian hypertensive patients. METHODS It will be a prospective, rater blinded, randomized, controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrolment if they are over 35 years of age, newly diagnosed with hypertension, or known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring or usual care arm. The telemonitoring arm involves of a weekly telephone call for collection of the home BP measurements, therapeutic education, treatment compliance assessment, as well as having a monthly call for treatment titration and side effects check. Randomization will be done by use of interactive web responsive system (IWRS) and will be stratified by investigation centers. Neither participants nor investigators will be masked to groups’ assignment. The primary outcome is the change from baseline in the 2 groups of mean 24-hour systolic blood pressure (SBP) at 6 months of follow-up. All randomized patients who will attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis. RESULTS Recruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection at the end of 2021 and plan the dissemination of the results subsequently. CONCLUSIONS The HOROSCOPE trial will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring along with self-monitoring in a Tunisian hypertensive population consulting in primary care. CLINICALTRIAL Trial Registration: ClinicalTrials.gov identifier: NCT04607239;

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